PATHOLOGY WRITTEN EXAM I

1. All of the following are features of mitral valve prolapse syndrome EXCEPT:

A. predisposition to infective endocarditis

B. systolic click and murmur

C. myxomatous degeneration of valve leaflets

D. neovascularization and commissural fusion of valve leaflets

E. predisposition to spontaneous rupture of chordae tendineae

2. After binding to endothelium, leukocytes transmigrate across endothelial junctions.

The adhesion molecules involved in the transmigration phase are:

A. E selectin (ELAM-1) and sialyl-LeX glycoprotein

B. P selectin (GMP-40) and sialyl-LeX glycoprotein

C. LAM-1 ligands (glycoproteins) and L-selectin (LAM-1)

D. ICAM-1 (immunoglobulin) and LFA-1 (CD11a/CD18 integrins)

E. PECAM-1 (immunoglobulin) and CD31 (immunoglobulin)

3. Patients with which one of the following diseases are not likely to be positive for

antinuclear antibodies (ANA)?

A. Lupus

B. Scleroderma

C. Dermatomyositis

D. Wegeners granulomatosis

E. Sjogren syndrome

4. A key mechanism for the formation of lipid-laden foam cells in atherosclerotic plaques

is:

A. synthesis of high density lipoprotein (HDL) by smooth muscle cells

B. secretion of interferon gamma by T lymphocytes

C. production of C-reactive protein by endothelial cells f

D. uptake of oxidized low density lipoprotein (LDL) by macrophages /

E. synthesis of collagenous matrix by fibroblasts

5. A 26-year-old pregnant woman is found to have blood type O Rh negative. The baby's

father is O Rh positive, and the fetus is O Rh positive. This is the mother's third

pregnancy. Which of the following best describes the mechanism for destruction of the

baby's red blood cells?

A. Type I Hypersensitivity - Immediate hypersensitivity

B. Type II Hypersensitivity - Antibody mediated cytotoxicity

C. Type III Hypersensitivity - Immune complex deposition

D. Type IV Hypersensitivity - Delayed type

E. No concern since both the father and baby are Rh+

6. All of the following participate in phagocytosis and destruction of bacteria by activated

neutrophils EXCEPT:

A. release of lysozyme and other lysosomal enzymes

B. production of superoxide and hypochloride radicals

C. attachment of bacteria to an Fc receptor and complement C3 receptor on the

leukocyte cell membrane

D. activation of NADPH oxidase and myeloperoxidase

E. cytokine-induced expression of VLA-4 and other integrins on the leukocyte cell

membrane.

7. The key compensatory mechanism in response to hemorrhage and most other causes

of shock is:

A. increase in venous filling pressure of the heart

B. renal sodium excretion

C. dilatation of peripheral venules

D. constriction of peripheral arterioles

E. bradycardia (showing of the heart rate)

8. A 35-year-old man previously in good health develops chest pain and shortness of

breath following an airplane trip from the Houston to Australia. Which of the following

most likely contributed to this patient's condition?

A. Viral pneumonia from exposure in recirculated air

B. Thromboembolus due to stasis of blood in deep leg vein

C. Air embolus from too rapid decompression

D. Fat emboli from bones of the extremities

E. Myocardial infarction from decreased oxygen at high altitude

9. A 60-year-old woman with a hepatocellular carcinoma is found to have a peripheral

blood erythrocytosis with an increased hemoglobin and hematocrit. The erythrocytosis

most likely is:

A. Immune response to a tumor

B. Tumor progression

C. Unrelated to her tumor

D. Paraneoplastic syndrome

E. Result of metastatic tumor to her bone marrow

10. A 6-year-old boy is found to have Burkitt lymphoma, an aggressive type of B cell

lymphoma. Analysis of the tumor demonstrates a growth fraction of 70%. Based on this

information, which of the following statements is most likely true regarding this tumor?

A. Since the tumor has likely been present for sometime, the presence of subclones is

not likely.

B. The percentage of cells in S phase is low compared to normal B lymphocytes.

C. The proliferative pool is small in this tumor.

D. This tumor is likely to be polyclonal in origin.

E. The tumor cells are more likely to respond to chemotherapy since there is a high

growth fraction.

11. The first step in the pathogenesis of carbon tetrachloride (CCI4)-induced liver injury is:

A. increase in permeability of the cell membrane due to covalent binding of CCI4

B. CCI4-induced detachment of ribosomes from rough endoplasmic reticulum

C. CCI3.-induced triglyceride synthesis

D. CCI3.-induced calcium efflux

E. conversion of CCI4 to Cl and CCI3 radicals by smooth endoplasmic reticulum

Greatest risk for Cardiomyopathy of Pregnancy is:

A. Asian, nulliparous women under 30 years of age

B. Hispanic, nulliparous women older than 30 years of age

C. White, multiparous women under 30 years of age

D. Native American, nulliparous women older than 30 years of age

E. Black, multiparous women older than 30 years of age

13. A 36-year-old woman undergoes bone marrow transplantation (BMT) following

high-dose chemotherapy and total body radiation therapy for cancer. Two weeks after

BMT, she develops skin rash, diarrhea and jaundice. Which of the following

mechanisms is most likely involved in these symptoms?

A. Anaphylactic reaction to foreign antigens

B. Donor T and B cells are reacting to the recipient's tissue antigens

C. Excessive immunosuppression has resulted in opportunistic infections

D. Host immune system is rejecting the engrafted cells

E. Vasculitis caused by immune complex deposition

14. All of the following participate in ischemia-induced cell membrane damage leading to

oncositic necrosis EXCEPT:

A. peroxidation of membrane phospholipids due to effects of toxic oxygen radicals

B. loss of membrane phospholipid asymmetry due to redistribution of

phosphotidylserine to the outer membrane leaflet

C. increased membrane permeability due to incorporation of free fatty acids and other

lipid molecules

D. disruption of the membrane's cytoskeleton connections due to protease activation

E. phospholipid depletion due to phospholipase activation

15. All of the following are likely to precipitate angina pectoris EXCEPT:

A. coronary endothelial production of prostacyclin

B. exercise-induced tachycardia

C. coronary vasospasm

D. platelet aggregation on a coronary plaque

E. hemorrhage into a coronary plaque

MATCHING: Match the carcinogen with the type of tumor with which it is associated.

Use each answer one time only.

16. Human papilloma virus A. Gastric cancer

17. Polycyclic hydrocarbons from cigarette B. Burkitt lymphoma

smoke C. Skin cancer

18. Arsenic D. Lung cancer

19. Epstein Barr virus E. Cervical cancer

20. Nitrosamines from smoked foods

21. All of the following are important factors in granulomatous inflammation EXCEPT:

A. accumulation of epithelioid macrophages

B. activation-of cell-mediated immunity to inciting agent

C. continued presence of indigestible organisms or particles

D. accumulation of lymphocytes

E. brisk acute inflammatory reaction with abundant neutrophils

22. A 4-year-old boy becomes progressively short of breath at a birthday party and is taken

to the emergency room. History taken from the mother reveals that the child drank

punch at the party that contained orange juice, and that he is "very allergic" to citrus

fruit. His difficulty breathing started within five minutes of drinking the punch. Physical

examination demonstrates an extremely anxious child gasping for breath with swollen

lips and tongue. Which of the following mechanisms is most likely involved in this

case?

A. Immune complex deposition in vessels of the larynx and soft tissues in the neck

B. NK cell activation upon exposure to citrus antigens

C. T-cell cytotoxicity against antigens in citrus fruit

D. IgA binding to macrophages containing phagocytized citrus antigens

E. Mast cell activation by cross-linked IgE molecules specific to chemicals in citrus fruit

23. The role of hemodynamic forces in atherogenesis is manifest by all of the following

EXCEPT:

A. localization of lesions in areas of turbulent blood flow

B. propensity of plaque formation adjacent to the bifurcation of the common carotid

artery

C. propensity of plaque formation in the ventral thoracic aorta

D. propensity of plaque formation in the lower abdominal aorta

E. hypertension as a risk factor for atherosclerosis

24. The most common cause of combined stenosis and incompetence (regurgitation) of

the mitral valve is:

A. infective endocarditis

B. redundant, floppy mitral valve

C. traumatic rupture of chordae tendineae

D. rheumatic heart disease

E. ischemia/infarction of a papillary muscle

25. Which of the following factors would be most likely to impede or limit the spread of a

malignant tumor?

A. Presence of receptors for endothelial cells on the surface of tumor cells.

B. Increased number of laminin receptors on the surface of tumor cells.

C. Coating of tumor cell emboli by platelets in the peripheral blood.

D. Increased production of collagenase by the tumor cells.

E. Increased number of NK and CD8+ T cells in the peripheral blood and infiltrating

the tumor.

26. Mechanisms involved in the kidney's role in blood pressure regulation include all of the

following EXCEPT:

A. renal prostaglandin production

B. changes in sodium reabsorption

C. renin release

D. renal effects of aldosterone

E. neurogenic regulation of vasomotor tone

27. A 58-year-old woman is treated for breast cancer with surgery and chemotherapy. She

appears to be disease free for five years, but then is found to have metastatic breast

cancer in her bones. Analysis of the primary tumor demonstrates mutations in ras and

her2-neu genes. Analysis of the metastatic tumor demonstrates mutations in ras,

her2-neu, P53, and fas genes. These findings involving genetic alterations suggest:

A. Homing of tumor cells

B. Differentiation of the tumor

C. Dedifferentiation of the tumor

D. Tumor progression

E. Malignant transformation

28. A functional pattern that presents as a systolic disorder is seen in:

A. Radiation fibrosis

B. Endomyocardial fibroelastosis

C. Friedreich's ataxia

D. Idiopathic hypertrophic subaortic stenosis

E. Infective myocarditis

29. An occlusive vasculopathy with intimal proliferation causing Raynauds phenomenon,

pulmonary hypertension or renal failure is most characteristic of which one of the

following diseases?

A. Polymyositis

B. Polyarteritis nodosum

C. Scleroderma

D. Rheumatoid arthritis

E. None of the above

30. All of the following are typical of long-standing primary essential hypertension

EXCEPT:

A. hyaline arteriolosclerosis

B. rapidly progressive renal failure

C. arteriosclerosis of aorta

D. left ventricular hypertrophy

E. prevalence highest in black females

31. A key early step in initiation of the extrinsic pathway of apoptosis is:

A. translocation to the nucleus of the nuclear transcription factor, NF kappa B

B. formation of the apoptosome with caspase 9 activation

C. overexpression of the Bax protein

D. release of cytochrome c from the mitochondria

E. activation of the death domain of the tumor necrosis factor (TNF) receptor

32. A 20-year-old woman is evaluated for recurrent gastrointestinal infections and found to

have decreased serum IgA. Which of the following conditions is also associated with

this disorder?

A. Decreased number of peripheral blood CD4+ T cells

B. Increased number of peripheral blood NK cells

C. Enlarged lymph nodes

D. Anaphylactic response to blood products containing IgA

E. Small or absent thymus

33. All of the following are mechanisms of steatosis (fatty change) of the liver EXCEPT:

A. carbon tetrachloride-induced inhibition of synthesis of lipid acceptor proteins

B. increased load of fatty acids due to mobilization of fat from adipose tissue by

starvation

C. alcohol-induced functional defects in mitochondria and endoplasmic reticulum

D. diet-induced increase of cholesterol synthesis and lipoprotein production

E. hypoxia/ischemia-induced inhibition of fatty acid oxidation

34. A 65-year-old man develops left-sided heart failure after a recent myocardial infarction.

Which of the following is most likely to be present in this patient?

A. Pulmonary edema

B. Renal vascular constriction

C. Bilateral jugular vein distention

D. Portal hypertension

E. Congestive hepatomegaly

35. A 60-year old woman complains of difficulty arising from chairs and combing her hair

because of weakness. Her exam shows 4/5 weakness in proximal muscles of arms and

legs. She also has a lilac (heliotype) colored rash on her eyelids and some skin

papules over her knuckles. What is the most appropriate diagnostic description?

A. Polymyositis

B. Lupus erythematosus

C. Dermatomyositis with high likelihood of underlying malignancy

D. Dermatomyositis with low likelihood of underlying malignancy

E. None of the above

36. A 34-year-old HIV seropositive man is seen at a community clinic. Which of the

following findings is a criterion for the diagnosis of AIDS?

A. Peripheral blood CD4+ T cell count less than 200/mm3

B. Hypergammaglobulinemia

C. Enlarged lymph nodes

D. Localized skin rash

E. Ten pound unintentional weight loss

37. The factor that favors resolution of inflammation with restitution of normal structure is:

A. abundant granulation tissue formation

B. persistence of injurious agent

C. tissue containing stable or labile parenchymal cells

D. connective tissue framework destroyed

E. extensive necrosis of parenchymal cells

38. Rheumatoid nodules may occur in which of the following organs?

A. Lungs

B. Myocardium

C. Cardiac values

D. Eye

E. All of the above

39. A newborn male infant has marked hypocalcemia and severe congenital heart defects.

Which of the following is also likely to be present in this patient?

A. Spinal bifida

B. Enlarged adrenal glands

C. Absent thymus gland

D. Decreased immunoglobulins

E. Cleft palate

40. A characteristic feature of pure (isolated) left ventricular failure is:

A. ankle edema

B. distended neck veins

C. hepatomegaly

D. pulmonary congestion and edema

E. pericardial effusion

MATCHING: For each numbered item (column 1), choose the letter of the most closely

related item in column 2. Each answer can be used once, more than once, or not at

all.

COLUMN I COLUMN 2

41. Complement C5a A. pain

42. Bradykinin B. chemotaxis and leukocyte activation

43. Interleukin-6 C. vasodilatation and bacterial killing

44. Nitric oxide D. production inhibited by aspirin and

45. Thromboxane A2 indomethacin

E. fever

46. All of the following are causes of aortic stenosis or left ventricular outflow tract

obstruction EXCEPT:

A. fibrosis of a congenitally bicuspid valve

B. hypertrophic cardiomyopathy

C. valvular calcification in the elderly

D. dissecting aneurysm involving the aortic root

E. rheumatic heart disease

47. A 25-year-old pregnant woman reports that she has not felt fetal movement in about a

week. On examination, there are no fetal heart sounds, and ultrasound studies show

no fetal heart beating and no other movement. She is hospitalized and soon after